Developing and putting in place ‘reasonable adjustments’

GPs are a trusted source of advice for
patients and also for employers. They therefore play an
important role in ensuring that the right changes are made to
working conditions to enable employees to continue to be in work
and reduce the chances of an employee having to be absent from work
due to sickness.

The Equality Act 2010 replaces the Disability
Discrimination Act 1995 and 2005, and began to be implemented from
October 2010. It means that employers and service providers
have to make reasonable changes to ensure that people with a
disability are not disadvantaged substantially compared with
non-disabled people.

The types of ‘reasonable adjustment’ that can
support people with mental health problems stay productive at work
are changes that are relatively easy and inexpensive to put in
place with some thought and preparation. It is also worth
reminding your patients that many people without a disability or
without a mental health problem need to make changes to their work
patterns and conditions. Some people need more flexible
working conditions because they have caring responsibilities,
others with long term or fluctuating health conditions also need to
make changes to the way they work.

A key theme running through Realising
Ambitions, the Perkins review of employment support, in the
testimonies of users of mental health services is the importance of
support from members of the community mental health team.
These professionals can help build self-esteem and confidence and
help to reinforce the message that it may take time to find the
right adjustments and for these to make a difference. You may
want to review the reasonable adjustment agreement after a set time
to see if further changes need to be made. You might also
have to help your patient, and the employer, to be persistent and
tenacious in finding and making the changes that make the positive
difference.

Access to Work is a valuable, but underused, Department for
Work and Pensions (DWP) scheme designed to financially assist
employers with costs beyond that of reasonable adjustments, helping
to produce a more efficient support system in the workplace.

Some suggestions for ‘reasonable adjustments’
are:

Allowing a person who found that
the stress of a formal interview exacerbated his mental health
condition to, instead, work (unpaid) to assess his suitability for
the job.

Allowing a person who had
difficulty travelling in crowded trains to start early and finish
early in order to avoid the rush hour.

Relieving an administrator of
the expectation that he relieve the receptionist during her lunch
break because he found this contact with the public aggravated his
mental health condition.

Changing usual shift patterns to
allow a longer period of night shifts (rather than the usual one
week) because changing the schedule of his medication in the
transfer from day to night shifts was problematic.

Arranging for someone who became
very drowsy after her monthly medication to take a day off and make
up the hours elsewhere.

Appointing a ‘buddy’ or ‘mentor’
– someone on a similar grade and outside the usual management
structure – to show the new employee the ropes and help them settle
in to the workplace.

Enabling a person to arrange
their hours to permit them to attend a weekly therapy
session.

Permitting someone to take ten
minutes out of the office when he became particularly anxious
.

Ensuring that a manager who
found the pressure of large meetings very difficult, arrange her
diary so that she had at least 15 minutes between
meetings.

Providing written instructions
for someone who was very anxious about forgetting to do things that
were expected of him.

Gradual return to work after
periods of sickness absence.

The possibility of working from
home, reduction in hours or relief from some responsibilities to
prevent the person having to take time off sick during fluctuations
in their condition.

Allowing someone who became
particularly paranoid at times to call a friend/support worker for
support and reassurance.

Arranging for someone who found
the distractions of an open-plan office detracted from her work
performance to have her desk in a quieter area.

Enabling a person to arrange
their annual leave to allow regularly spaced breaks throughout the
year.

Creating the possibility of
part-time working and job-share arrangements for someone who was
unable to work full time.

Links
to resources:

This section of the website
explains the term ‘reasonable adjustment’ and includes links to
specific guides for line managers which may be useful when working
with employers. This page on the website includes the link to
the publication ‘We can work it out’. This is a line
manager’s guide to reasonable adjustments for mental illness.

This is an initiative to
tackle stigma and discrimination surrounding mental health issues
in England. The campaign aims to create a society where people who
experience mental health problems enjoy the same rights and
opportunities as other people. The website has links
specifically for employers. The line manager’s resource is a
practical guide to managing and supporting people with mental
health problems in the workplace.

Employers' Forum on
Disability is an employers' organisation focused on disability as
it affects business. The forum includes employers from
multinational corporations, Small and Medium sized Enterprises and
the public sector.

This review was commissioned
by the Secretary of State for Work and Pensions to look at mental
health and employment and to identify how Government could help
people with mental health conditions fulfil their employment
ambitions. Chapter
4 includes examples of ‘reasonable adjustments’ that have
enabled people with a mental health condition to prosper at
work.

This booklet ‘Flexible
working and work-life balance’ includes examples of flexible
working such as term time working, job shares and changes to shift
and rota patterns. It includes advice for employees on how to
apply for flexible working. The booklet includes examples of
flexible working from situations such as returning to work after
maternity leave which might be useful in discussions with your
employees, especially where you or they have limited experience or
knowledge of mental ill-health.

‘The Mental health in the
workplace: an employer's guide’ includes a section on
supporting employees to stay in the workplace.

The ‘Staying
in employment’ booklet by Alison Cobb and Kaaren Cruse is
written primarily for people who experience mental distress, or are
living with a mental health diagnosis. It includes sections
on making changes to the workplace such as the work environment or
working practice. It also includes information and advice on
getting support for putting the adjustments needed in place which
may be useful for employers when discussing and agreeing reasonable
adjustments with your patients and also with employers.

The health conditions part of
the website includes a link to an American publication called
‘Working with MS’. This includes tips and techniques
for developing adjustments or accommodations or different job
duties. There is a five point plan to help identify the tasks
and activities that your patient can do and those which s/he may
experience difficulties with and how best to negotiate for the
adjustments needed.